Patient: Dear Doctor,I am a male 23 year-old biology and chemistry graduate with no medical conditions and under no medication. Put simply, I am suffering from low sex drive and erectile dysfunction.So basically last summer I noticed that I could not get even the slightest bit erect when kissing/fondling/etc a real woman. At first I thought it was because I was drunk or due to performance anxiety, but I also realised I struggled to get it up alone and with porn. Naturally I got not only worried but terrified and started doing some research online. Now I used to watch quite a lot of porn (perhaps once or twice a day on average), and where once I could get fully erect just by fantasising a bit, I could barely get a slight erection.After some research, the Internet mostly said that porn is largely to blame, and several websites say that too much porn eventually causes desensitisation of dopamine and kills your sex drive and causes erectile dysfunction. The only way to remedy this, they say, is to ‘reboot’ your hormones by stopping porn and reducing (ideally eliminating) masturbation. At the time I was sceptical, but decided to try it out and see the results.So from September 2014, I decided to stop not only porn but also masturbation. For the most part, I managed. It is now end of April and it has been an amazing 7 months since I last watched porn, and 3 months since I last masturbated. Between September and January, I only masturbated maybe 5-7 times, and not more than that. I have found that masturbation only makes things worse.I have noticed improvements since then – where I just could not get it up with a partner, I can now get it fully erect sometimes – but inconsistently, and even if I do get fully erect it goes down relatively quickly. I have gone to two doctors – one a GP and one a urologist, and they have both told me porn has nothing to do it and I was suffering from anxiety and other psychological issues. Now it should be pointed out that I regularly have nocturnal and morning erections and nocturnal emissions, but I feel that after 7 months I must do better than just getting fully erect occasionally and briefly.I have taken Viagra and have noticed an improvement whenever I take it, but not a great one. I’ve also tried taking l-arginine and pycnogenol, which improved things a bit but not by much either.My sex drive has also gone down drastically since stopping porn, and I’m not sure which is causing which – is the erectile dysfunction causing the low libido or viceversa?I should also state that I have been suffering from stress lately, but then again I am a biology and chemistry graduate so I’ve been feeling stress for years anyway.To conclude: I’m at a total loss of what the hell is happening to me and nothing seems to work. Is it due to the ‘reboot’ not finishing, is it because of stress, or is it a combination of the two? Either way, I’m having trouble believing that things haven’t improved by much since September of 2014.Please help.
Doctor: Welcome to Ask The Doctor.You seem to be suffering from Erectile Dysfunction.The two most common causes of Erectil e Dysfunction in Males are Diabetic Neuropathy and Psychogenic Erectile dysfunction. You have not mentioned any history of diabetes but you should get your blood sugar tested. I would also advise you to get color Doppler of penile vessels.In such situation I advise following :1. To take Methylcobalamine supplementation.2. To use Sildenafil as on when required basis that is whenever sex is desired.3. To cut down alcohol in case you take as this reduces erection when sex is tried after consumption of alcohol.4. To keep blood sugars well controlled.This is my best opinion for you.You should discuss with your doctor before acting upon any advice.Stay healthy